The many faces of IoT (Internet of Things) in Healthcare

1. Image credits included in presentation THE MANY FACES OF IoT IN HEALTHCARE INTERNET OF THINGS

2. Machine to Machine (M2M) Hi, I’m... IoT Embedded Internet Web of Things A subset of IoT IPv6 may be adopted Machine-Type Communication (MTC) Internet of Things but my friends call me... but non-IP protocols are also used Intranet of Things Claro Partners Smart... SmartEnergy, SmartCity, SmartGrid, etc. Internet of Everything Cisco IoT evolving into WoT with integration into the Web Application layer using standard web protocols Industrial Internet GE... Replacement for SCADA & Telemetry ...also Industrial Internet Consortium and others Industrial Internet of Things (IIoT) Includes people, computers and data Connected devices but within proprietary platforms Vehicle to... ...Vehicle (V2V), ...Infrastructure (V2I), ...Anything (V2x) Ubiquitous Things that think computing

3. Almost ‘anything’ —including ‘living things’— connected to the internet regardless of location or other physical restrictions. Source: Gareth Baxendale, Head of Technology Services at the NIHR Clinical Research Network, WiFi enabled cows and the Internet of Things

4. Monitor Analyse Process, analyse and communicate data Trigger Alert Action Collect and record data Required action taken by device or human The Internet of Things is process driven

5. Today, there are already more things connected to the internet than people 26 billion 50 billion 75 billion 200 billion Number of devices predicted to be connected to the internet by 2020 The human brain has 86 billion neurons Flaming Lotus Girls Neuron by Ann Larie Valentine on Flickr https://flic.kr/p/75SmyS Cisco Morgan Stanley Intel Gartner

6. What does this look like in healthcare ?

7. Source: The Internet of Things Architecture, IoT-A

8. Higher quality delivery Both little data... What can IoT do for healthcare? Ability to react with speed ...and big data Ability to act at scale Can affect whole communities and cities

9. Broader model of healthcare Prevention & Wellness IoT has a far reaching impact across all determinants of health Figure Source: Dahlgren, G. & Whitehead, M. (1991) The main determinants of health in Policies and strategies to promote social equity in health: Background document to WHO—Strategy paper for Europe

10. Being able to monitor and support a person free from ‘physical constraints’ will change the way doctors deal with patients. Source: Gareth Baxendale, Head of Technology Services at the NIHR Clinical Research Network, WiFi enabled cows and the Internet of Things

11. 30.3% 69.7% Percentage of IoT devices found in healthcare Percentage of IoT devices found elsewhere* * Business/Manufacturing, Retail, Security, Transportation The predicted global worth of IoT in healthcare in 2025 $2.5 trillion Deployment of the Industrial Internet can help to drive down costs from clinical and operations inefficiencies by roughly 25% or about $100 billion per year Sources: Intel, A guide to the Internet of Things & General Electric Company (2012) Industrial Internet: Pushing the boundaries of minds and machines

13. “Have I taken my medication?” Day 304: New Meds by kizzzbeth on Flickr https://flic.kr/p/bCBGFk Inyección de insulina by Sari Dennise on Flick https://flic.kr/p/7LNKnN; Lifeblood by Andrew Butitta on Flickr https://flic.kr/p/6g5zCD; Pills by David K on Flickr https://flic.kr/p/5Ya3x; By Alex on Flickr https://flic.kr/p/84G5UR; Pudge with his inhaler by Thomas Widmann on Flickr https://flic.kr/p/NiwcR

14. Available to buy or in development today... ELECTRONIC PILL DISPENSERS Designed to remind individuals to take their medication at the right time and to ease the burden of complex medication regimens, electronic pill dispensers such as my uBox and MedMinder alert both the patient and their caregivers. SMART WATCHES Already designed to act as a health and fitness companion with all the capabilities of a fitness tracker, smart watches (such as Apple Watch) have the potential to integrate with multiple technologies, including those described here. ELECTRONIC BOTTLES, CAPS AND POUCHES Wireless smart pill bottles, such as Adheretech, measure the volume of tablets or liquid left in a bottle, while GlowCaps use light and sound to signal when it’s time to take your medication. Inhaler attachments, such as GeckoCap and Asthmapolis, monitor where and when an inhaler is used. ‘PHARMACY ON A CHIP’ Currently undergoing clinical trials, microchips drug delivery technologies administer controlled doses of a drug at precisely the right time via a microchip inserted on the waist. Still in its infancy, the technology holds promise for improved patient adherence managed remotely. BIOMONITORING DRUGS Ingestible sensors as small as a grain of sand exist today. Helius by Proteus Digital Health is a digital health feedback system. Embedded in a tablet, sensors communicate with a patch worn on the stomach. This then relays information to your phone, and further to your support network and care providers.

15. “I want to track my own health and that of loved ones.” Pregnancy by Titiana Vdb on Flickr: https://flic.kr/p/e4nLge Image by Darran Baldwin: https://flic.kr/p/fff9ut Runner by Stuart Grout on Flickr: https://flic.kr/p/9HXRiX Bathroom scale by Magnus D on Flickr: https://flic.kr/p/8oDVuo

16. Available to buy or in development today... FITNESS Designed to provide insights into our own health and motivate us to increasing levels of fitness, many of us are no doubt familiar with wearables that track our activity, such as the Jawbone UP, Fitbit, or more recently, Misfit Wearables’ Shine. LG and Intel also both produce smart ear buds that monitor your pulse. HOME MONITORING Home monitoring matters to both families and care providers alike as it enables independence. Systems such as Sensormind, Sonamba, Numera Libris and Libris+ use sensors to detect activity, analyse behaviour and automatically detect problems. WELLBEING Psychological wellbeing is vitally important and IoT can help. From wearables focused on breath patterns and fitness, such as Spire and Lumafit, to stress mapping bicycle helmets, such as MindRider. Or what about Olive, an intelligent bracelet that monitors heart rate, skin conductance, ambient light, motion and skin temperature? FAMILY IoT knows few bounds when it comes to supporting our loved ones. From the virtually invisible electronics of MC10 (above) to Pixie Briefs smart nappies, which analyse urine, check hydration levels and identify signs of UTIs. Kolibree is a connected and gamified electric toothbrush, while other wearables help keep track of your pregnancy. CLINICAL SUPPORT AliveCor is a heart monitor that attaches to your smart phone and is capable of recording ECGs. Physicians can use the technology to detect arrhythmic cardiac disease, irregular heartbeat or abnormal heart rhythm. AliveCor ECGs can also be automaticallly uploaded into select Electronic Health Records (EHR).

17. “Can we get to the scene of an emergency faster?” DSC08469 by perthhdproductions on Flickr https://flic.kr/p/daiBwA; Ambulance in Motion by Benjamin Ellis on Flickr https://flic.kr/p/6qa5ym; Paramedic at Vauxhall Helicopter Crash by R4vi on Flickr https://flic.kr/p/dM8x4M; London Air Ambulance by Smudge 9000 on Flickr https://flic.kr/p/4UQzUK

18. eCall (an interoperable, harmonised in-vehicle emergency call system) will be mandatory in all new car and van models produced within the European Union by October 2015 Sources: HeERO Harmonised eCall European Pilot & Daily Mail (2014) EU to bug every car in UK with tracker chips

19. “We want to prevent and control infections.” MCs Visit to the Hospital by kris krüg on Flickr https://flic.kr/p/cyVcQ; Washing hands (before shot)_0033 by James Emery on Flickr https://flic.kr/p/4xFfxG; Clean Hands by Arlington County on Flickr https://flic.kr/p/7zg6GJ; Poke by Thirteen of Clubs on Flickr https://flic.kr/p/9jfqsg

20. To reduce healthcare associated infections (HAIs), companies such as Intelligent M, HyGreen, IBM in collaboration with OhioHealth, and BIOVIGIL are creating sensor technologies and networks to monitor hand washing practices in real-time. Sources: Postscapes, Intelligent M: Reducing infection through RFID; Postscapes, Hand hygiene monitoring system: HyGreen; BIOVIGIL; eWeek (2014) IBM, OhioHealth use big data to prevent infections in hospitals

21. “Is it possible to develop a predictive lifesaving approach?” Inside the air ambulance on 17th from Rourkela to Bhubaneswar by Sadasiv Swain on Flickr: https://flic.kr/p/ovrc7s; EEG with sleeping boy by Jemaleddin Cole on Flickr https://flic.kr/p/d8szf; A mother’s hands by Cheryl on Flickr https://flic.kr/p/5QRFfo; Canberra Hospital Walk-in centre staff at work by DIBP images on Flickr https://flic.kr/p/9tTxUR

22. The LIFEPAK 15 portable heart monitor and defibrillator allows medics in the field to capture patient data and send this information directly to the hospital. Such M2M technology enables faster response times. It also ensures that patients are routed to the correct hospital for treatment, appropriate caregivers are notified and swift diagnosistic decisions are made. IBM are working on a host of predictive solutions designed to improve healthcare in real-time, enable faster interventions and save lives. Project Artemis, developed in collaboration with the University of Ontario Institute of Technology and the Toronto Sick Kids Hospital, allows subtle changes to be detected in nosocomial infected infants 12 to 24 hours before any outward signs appear. Other projects aim to detect complications in brain injured patients, stroke victims and critical patients in ICU before they occur. Sources: PTC (2014) Saving lives: ambulances get connected to the IoT; M2MNow (2011) Multi-tech cellular development platform and Physio-Control combine to save lives; IBM Big data in healthcare: real-time health monitoring and intervention; IBM (2013) UCLA relies on breakthrough ‘big data’ technology from IBM to help patients with traumatic brain injuries; IBM (2010) IBM Analytics helps medical researchers detect complication in stroke patients; IBM (2013) Emory University Hospital explores ‘Intensive Care Unit of the Future’

23. “We want to increase medical device utilisation.” CT Scanner, Crash Cart by Civilian Scrabble on Flickr https://flic.kr/p/vUki6; treat2 by MilitaryHealth on Flickr https://flic.kr/p/cRK86s; Big MRI by liz west on Flickr https://flic.kr/p/kJ4Pa

24. There are 105,000 CT scanners and MRI machines globally By connecting medical devices and machines to the internet it becomes possible to monitor in real-time, run remote diagnostics, provide virtual hands-on support, automate replenishment and analyse utilisation. Using IoT, Varian Medical Systems have seen a: 50% reduction in mean time required to repair connected devices $2,000 reduction in service costs for each problem resolved remotely 20% fewer technician dispatches worldwide Sources: Forbes (2014) 3 ways the Internet of Things is revolutionizing health care & General Electric Company (2013) The Industrial Internet @ Work

25. “As a nation, effective public health policy is important.” Crowds by H. Michael Miley on Flickr https://flic.kr/p/f9Jjxv; Driving Cars in a Traffic Jam by epSos.de on Flickr https://flic.kr/p/9w8eWL; Map of London sewers Westminster by Matt Brown on Flickr https://flic.kr/p/83ZKDt; GWU School of Public Health Building 42840 by Ted Eytan on Flickr https://flic.kr/p/nUc1et

26. Underworlds: smart sewage system Examining aggregated wastewater across several cities, the Underworlds project is designed to establish the techniques and technologies required to deploy a near-real-time network of biosensors, automata and purpose-built labs. Once realised, this will enable real-time public health strategies, inform policy, and provide greater insight into urban health. Source: Wired UK (2014) ‘Smart toilets and sewer sensors are coming’ Decorated sewer cover by Chris Schrier on Flickr https://flic.kr/p/9jVFCd

27. Sparks to ignite a flame Tea candle in the dark by Markus Grossalber on Flickr https://flic.kr/p/du6AgS

28. Healthcare is a late and slow adopter of technology Reputedly one of the slowest adopters —second only to shipping The bow of Majestic Maersk by teralaser on Flickr https://flic.kr/p/gbi4Kg Sources: The Healthcare Industries Task Force (2004) & Tim Jones, Board Member West Midlands AHSN (2013)

29. An unofficial online survey of WiFi availability for frontline NHS staff found only 23% had access to free WiFi Others were denied access even where WiFi was available or had to pay for it Source: Professor Jonathan Kay, Clinical Informatics Director, NHS England (2013) Survey run by NHS Hack Day community with support from HANDI Health, Tactix4 and openGPSoC; 650 respondents Free WiFi by Sébastien Bertrand on Flickr https://flic.kr/p/juq2v

30. Information governance challenges are significant Interoperability | Data integrity Access control | Data quality | Security and Compliance Back to Work by Death to the Stock Photo

31. Source: Almost Human, ‘Arrhythmia’, Season 1, Episode 6

32. Source: Wired (2014) It’s insanely easy to hack hospital equipment 2 year study All medical equipment: radiology, MRI, ultrasound, mammography systems, cardiology, oncology, lab systems, surgical robots, fetal monitors, ventilators, anesthesia It was possible to deliver random shocks to a patient’s heart, remotely manipulate drug dosages, change radiation exposure limits in CT scanners and alter digital medical records

33. Reimbursement for digital health interventions is still a work in progress. Steve Blank The stakeholder landscape is challenging—more often than not, the economic buyers and end users are not the same but both need to be convinced! WBS International Healthcare Case Competition 2014 Sources: Rock Health (2014) Reinventing Life Science Startups Part II: The rise of digital health & WBS International Healthcare Case Competition Participant Briefing: Part 1 Business Model Canvas: Business Model Generation

34. How will change happen?

35. Adoption of industrial internet by healthcare How will change happen?

36. Adoption of industrial internet by healthcare How will change happen? Consumer adoption and demand

37. Adoption of industrial internet by healthcare Change is inevitable Consumer adoption and demand

38. Make your own healthcare role IoT enabled Lobby for change and access to IoT in your healthcare environment Educate yourself on what’s available. There’s usually a tech solution out there somewhere! Recommend IoT solutions to patients Use IoT for your own benefit Find an executive sponsor or innovation champion to support you Make a note of patient recommendations and share these with your colleagues I’m a healthcare professional. What can I do? 1 2 3 4 5 6 7

39. Use Google to learn about Healthcare IoT solutions Lobby for change with your doctor and consultant Recommend IoT solutions I don’t work in to friends healthcare. What can I do? Use IoT for your own benefit Buy IoT presents for people Join a patient group Become politically active 1 2 3 4 5 6 7 8 Start an IoT business

40. If you would like support to develop your Internet of Things strategy or would like to understand the disruptive nature of these new technologies and business models, contact the Stocker Partnership and get started today! +44 (0)24 76 100 193 hello@stockerpartnership.com

41. STOCKER PARTNERSHIP The Stocker Partnership is a strategic innovation consultancy We help organisations to create and exploit new opportunities 024 76 100 193 hello@stockerpartnership.com Matt Stocker Debbie Stocker www.stockerpartnership.com Follow us on LinkedIn Subscribe to our blog Sign up to our newsletter WE’RE NOT BIG BUT WE ARE CLEVER @mattstocker @debbiestocker Illustrations by Stina Jones (stinajones.co.uk), and Matt Stocker